Claim Associate I LevelUP

Overview

At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.    

Reasons you should consider a career with CCMSI:

• Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
• Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
• Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
• Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

The Claim Associate I LevelUP position is designated for the first and second phases within the CCMSI-U LevelUP Career Pathways Program. Individuals classified in this program are designated as participants in the LevelUP Pathway which is an internal training program for participants/employees to be considered for promotion to a Claim Associate II (Phase 3 & 4) followed by Claim Rep I (Phase 5).  The Claim Associate I LU investigates and evaluates contested medical-only claims and handles mostly non-litigated indemnity cases under close supervision. Accountable for the quality of claim service as perceived by CCMSI clients and within Corporate Claim Standards.

All Claim Associate II LU’s will be expected to be promoted into a Claim Representative I position once they have achieved the necessary skills and competencies (per the LevelUP requirements). Refusal to accept the advancement to Claim Associate II LU or Claim Representative I position may result in being re-classified to another position if available or withdrawal of the employment offer.

Responsibilities

• Investigate, evaluate and adjust medical only claims, contested medical-only claims and handle a maximum of 30 indemnity claims under direct supervision.  
• Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision. 
• Set up designated claim files and complete all set up instructions, as requested. 
• Set up independent medical exams as deemed necessary under direct supervision. 
• Request and monitor medical treatment of designated claims in accordance with corporate claim standards. 
• Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision. 
• As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e., legal surveillance, case management, etc.) 
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process. 
• Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision. 
• Compute disability rates in accordance with state laws under direct supervision, when appropriate. 
• Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim. 
• Review and maintain personal diary on claim system. 
• Provide technical and clerical claims support to designated clients, as requested. 
• Compliance with corporate claim standards and special client handling instructions as established. 
• Will act as a back-up to designated adjusters when needed. 
• Performs other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position is designated for the LevelUP Career Pathway Program which is an internal career pathway position designed to provide training for consideration as a Claim Representative. In order to be successful in this position, the candidate must possess the following skills and attributes:

• Possess a long-term career goal to work in insurance as an adjuster.
• Excellent oral and written communication skills.
• Individual must be a self-starter with strong organizational abilities.
• Proven ability to demonstrate independent critical thinking skills.
• Ability to coordinate and prioritize required with exceptional time management.
• Ability to operate general office equipment and perform clerical duties.
• Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
• Discretion and confidentiality required.
• Ability to work as a team member in a rapidly changing environment.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.
• Ability to clearly communicate verbally and/or in writing both internally and externally.

Education and/or Experience                                                                

Associate’s degree or two year’s related business experience.

Knowledge of medical terminology preferred.

Commitment and willingness to learn roles with increasing decision making authority and responsibilities.

Computer Skills         

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

Must pass Adjuster license exam as required for the respective jurisdiction(s).

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.